We are endangered by the rise of antibiotic resistance

Without antibiotics, no surgery is possible, without antibiotics, no cancer treatment. Without antibiotics, a simple bicycle fall can mean death.

Yet, Humanity is dilapidating this precious resource

The weaknesses in the battle against antibiotic resistance have remained:

The release of antibiotic containing waste in the environment, and of antibiotic-resistant bacteria containing waste from husbandry, continues.

Use of diagnostic tools is low, and antibiotics are still prescribed needlessly by doctors, pharmacists, over the counter shops, hospitals, while patients request them wrong-headedly.

The information – education campaign on the concept of antimicrobial resistance have yet to overcome misconceptions in the lay public as identified by the excellent Wellcome trust study.

People believe that the term ‘resistance’ applies not to bacteria but to the antibiotic or to the individual patient and many believe that if they don’t take antibiotics or have proper diet, their body cannot become ‘resistant’ (sic) and therefore AMR is of no concern to them.

Our actions

The WAAAR has focused its action on intense lobbying to advocate the following :

Controlled use of antibiotics

Cautious, controlled and surveyed approaches to the use of antibiotics in hospitals, husbandry, agricultural and veterinary settings.

Awareness-raising

Large information and awareness campaigns directed to the public on the proper use of antibiotics. Education and training programs for health care professionals.

Increased support to basic and applied research efforts in human and veterinary medicine. Incentives to stimulate research of new drugs via fast track developments of new antibiotics.

WAAAR Declaration

The increase in antibiotic resistant bacteria poses a major healthcare threat. In the face of an almost complete absence of new antimicrobial drugs in development, antibiotic resistance (ABR) has become one of the main public health problems of our time.

Antibiotics are a unique class of medications because of their potential societal impact; use of an antibiotic in a single patient can select for ABR that can spread to other people, animals, and the environment, making an antibacterial used in one patient ineffective for many others. Bacterial resistance can evolve rapidly. As bacteria acquire resistance mechanisms, the altered bacterial genetic material coding for resistance mechanisms can be transmitted at times readily between bacteria, broadening the reach and extent of resistance. Treatment failures because of multidrug resistant (MDR) bacteria, once rare, notable, and limited to hospitals, now occur very commonly in hospitals and increasingly in the community as well. It is estimated that at a minimum 25000 patients in Europe and 23000 in the USA die each year from infections caused by resistant bacteria. The cost of antibiotic resistance is tremendous, whether measured as the personal and societal burden of illness, death rates, or healthcare costs.

Although it is a never-ended phenomenon, antibiotic resistance is directly related to the volume of antibiotics used. We are using increasing amounts of antibiotics in health care and agriculture, and discharging these active drugs into the environment. The impact of widespread antibiotic use is enormous, promoting the development and dissemination of antimicrobial resistance.

Safeguarding antibiotics will require a concerted effort by citizens, patients and prescribers. The primary goal of WAAAR is to raise awareness about the urgency and magnitude of the threat and to promote an international dialogue to assist in effective responses. The Alliance, in particular through this declaration, is dedicated to actively promoting antibiotic preservation and to raising awareness among antibiotic prescribers, politicians and policy-makers, patient safety and advocacy groups, the pharmaceutical industry, international health organizations, and the general population. Individual actions, no matter how well intended, are doomed to failure unless there is an international dialogue, a common sense of purpose, and broad consensus on how best to proceed.

We must change how antibiotics are used and adopt proactive strategies, similar to those used to save endangered species. Preservation of the efficacy of antibiotics and to stabilization of antibiotic-susceptible bacterial ecosystems should be global goals.

We urge all of you to participate in this crusade, in your own field of interest. The medical miracle of antibiotic therapy must be protected – this is a global priority and our duty. Please, help us to act NOW, by supporting this declaration, to promote wiser use of antibiotics in animal and human health, and the necessary accompanying political actions to support better education, integrated surveillance for public health action, and research.

WAAAR advocates for the following 10 actions:

Promotion of awareness of all the stakeholders - including the general public - of the threat represented by antibiotic resistance

Strong cooperation among international political, economic and public health organizations, which, all together, must take the lead of this action against antibiotic resistance.

Organization, in each country, ideally by Ministries of Health or regulatory bodies, of a financed national plan for the containment of antibiotic resistance, with the participation of all stakeholders, including patient advocacy groups

Continuous access to antibiotics of assured quality, especially in middle and low income countries

Integrated Surveillance of antibiotic resistance (ABR) and antibiotic use Standardized monitoring of antibiotic use and resistance at institution, regional, and country (comprehensive national data instead) level (through a Centers for Diseases Control and Prevention model) to allow comparative statistics (benchmarking), to be updated preferably in real-time and at least every 12 months. This will require adequate laboratory capacity using international standardized methods that may be facilitated by a centralized technologic coordinating infrastructure and information technology

Use of diagnostic tests

Appropriate use of existing diagnostic tests and development and implementation of new rapid, cost-effective and accurate diagnostic tests, adapted to the local context, to aid in distinguishing bacterial and nonbacterial etiologies. Rapid diagnostics may help clinicians avoid unnecessary treatments, rapidly select appropriate targeted therapies and inform the duration of treatment

Antibiotic stewardship (prudent, controlled and monitored approaches to the use of antibiotics)

Development of large coordinated, effective information and awareness campaigns directed at the public on expectations about the rational/appropriate use of antibiotics.

Continuouseducation and training programs in the curriculum for all health care professionals in all settings (veterinarians, medical, dental, nursing, pharmacy and allied health care schools) and continuing professional education programs, on the rational use of antibiotics, including indications, dosing and duration of therapy. Education of farmers

Containment of bacterial transmission and prevention of infection

Promotion of universal hand hygiene and all infection control interventions that have been proven to reduce rates of resistance

Relentless efforts to prevent transmission of MDR organisms in healthcare, food production and animal husbandry

Programs to limit the contamination of drinking water with MDR bacteria, as well as contamination of the environment

Promotion of the use of available vaccines, in humans and animals

Basic and applied research, and development of new antibiotics

Increased support for basic and applied research aiming at curbing bacterial resistance in human and veterinary medicine.

Use of the principles of orphan drugs for new antibiotics

Incentives to stimulate research of new drugs (antibiotics and novel compounds) and vaccines via regulatory pathways that allow for fast track development.

New economic business models to support the cost of innovation while safeguarding public health interests.

Request for UNESCO to include the “concept of antibiotic” in the list of the intangible cultural heritage.

Wednesday, March 28th, 9:00-10:00 am EST (Washington, D.C.)

Strengthening systems to prevent antimicrobial resistance

Results from the West Bank, Uganda, and Georgia . From USAID ASSIST Project on Vimeo. Lisa Dolan-Branton and Tamar Chitashvili presented on ASSIST's experience in the West Bank, Uganda, and Georgia in a discussion moderated by Mir Rahimzai. Garance Upham, Vice-President of the World Alliance Against Antibiotic Resistance (WAAAR), provided expert commentary